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October 3, 2023
View from Here
Milbank State Leadership Network Primary Care Transformation Primary Care Investment
Christopher F. Koller
Nov 15, 2023
May 9, 2023
Mar 21, 2023
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“I got bad news. My doctor and I broke up.”
“Oh, man. What happened? I thought you guys really dug each other.”
“Yeah me, too. I dunno. It just changed. They got real distant. I couldn’t reach them anymore. And some of it was me. Stuff happened, I moved, got a new job — and I just lost touch.”
“That’s too bad.”
“Yeah. I miss them. I guess I will have to start all over again — but maybe not now.”
Healthy relationships make for healthy lives. That includes relationships with one’s regular health care provider. Compared to those without, people who say they have a regular place to go when they are sick or need medical guidance, report:
Having this usual source care (USC) also reduces the disparities in outcomes based on race and ethnicity that plague the US health care system.
So, it is concerning that the proportion of people reporting no USC in the US has steadily increased over the last 20 years, even as insurance coverage has expanded (Figure 1). This trend has grave consequences for health and health equity in the United States.
What do we know about establishing and maintaining these relationships? Research has shown:
But what about the downward trend? Who is breaking up with their regular clinician and why? A new Milbank Memorial Fund report examining who is gaining or losing a USC provides evidence that can inform public policy. Using data from the US Health and Retirement Survey, which queries people over age 50, researchers at Leading Age LTSS Center at UMass Boston gained the following insights.
The declines are systemic: the portion of people reporting a USC declined steadily between 2014 and 2020, regardless of age, gender, race/ethnicity, or income (Figure 2).
Life transitions matter: People were likely to gain a usual source of care if they developed a chronic illness or got a job. However, moving residences, becoming widowed, and becoming depressed left one more vulnerable to losing a USC.
Managed care helps: People enrolled in a managed care plan were more likely to maintain or gain a usual source of care.
More needs to be learned about the systemic nature of the decline in people reporting a usual source of care. Is this part of a larger trend towards social isolation? There may be associations between declines in USC and findings from sociologists about declines in community cohesiveness and individuals’ sense of belonging.
But lest we get caught up in a public policy doomscroll, the existing evidence makes it clear: helping more people obtain or keep a USC should be a public policy goal. This research suggests there are public and private policies to attain this goal, including:
Being alone can stink. Especially when one is sick. Relationships between patients and their regular clinicians are breaking up more often these days, and that is a grave threat to our individual and collective health. The reasons are more systemic than personal. To borrow a term from public health, public and private sector actors need to make the right choice the easy choice by incenting or even requiring the selection and utilization of a usual source of care in insurance benefits, strengthening the supply and capacity of primary care providers, and supporting people in their life transitions.
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An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.